Traumatic rupture of the tracheobronchial tree

Rupture of the trachea and major bronchi usually results from blunt trauma to the chest. To define the characteristics of the condition, the mechanism of injury, presentation and hospital course, the authors reviewed seven cases of tracheobronchial rupture after blunt trauma. Four were injured in a motor vehicle accident, two had a crush injury and one child had a fall from a playground swing. The site of injury was the left main bronchus in three, membranous trachea in two and bilateral bronchi and bronchus intermedius in one patient each. Bronchoplastic repair was performed in four patients with salvage of lung tissue in three. One patient required pulmonary resection. Two patients with a laceration of the membranous trachea did not undergo operation. Two patients died secondary to associated head injuries; one patient underwent repair of the bronchus intermedius and one patient had a lacerated membranous trachea. The possible mechanisms of injury are: rapid deceleration with forward swing of the trachea, widening of the transverse diameter of the chest, exerting traction on the carina, and a rapid rise of airway pressure on impact. Surgical intervention is recommended at an early stage to avoid loss of lung tissue.     

Transcervical-transtracheal endoluminal repair of membranous tracheal disruptions

Tracheal lacerations are rare and potentially hazardous complications of tracheal intubation. Surgical repair is the treatment of choice of tracheal injuries although nonoperative management is occasionally appropriate for well-selected patients. We describe our personal technique of anterior transcervical-transtracheal endoluminal suture of iatrogenic lacerations of the membranous trachea and our results with this approach in 8 patients. This method is less invasive than conventional cervical or transthoracic approaches.     

Intraoperative tracheal reconstruction with bovine pericardial patch following iatrogenic rupture

Introduction  

Iatrogenic injuries of the membranous trachea have become increasingly common and may trigger a cascade of immediate life-threatening complications.     

Blunt tracheal transection and long tear in posterior membranous trachea

Blunt tracheobronchial injuries are rare, but can be life-threatening. A precise preoperative diagnosis and a well-recognised plan of surgical treatment, which may be unique for each patient, are needed to restore the continuity of tracheobronchial tree in a one-stage intervention. We encountered a patient with complete tracheal transection and 15 cm tear in the posterior membranous trachea and right bronchus, and whose tracheal injury was difficult to repair using direct intubation of distal airway by bronchoscopy. We achieved a good result of one-stage repair using a percutaneous cardiopulmonary support (PCPS).     

Blunt tracheal transection

Blunt tracheobronchial injuries are rare, but can be life-threatening. A precise preoperative diagnosis and well recognized plan of surgical treatment, which may be unique for each patient are needed to restore the continuity of tracheobronchial tree in a one-stage intervention. We encountered 2 patients with complete tracheal transection of neck and 1 patient with complete tracheal transection in mediastinum and 15 cm tear in the posterior membranous trachea, whose tracheal injury was difficult to repair using direct intubation of distal airway by bronchoscopy. We achieved a good result of repair using a percutaneous cardiopulmonary support system (PCPS).     

Clinicopathologic study on the mode and degree of invasion of the trachea by thyroid carcinoma

Among 23 patients with thyroid carcinoma infiltrating to the trachea, total 7 laryngectomy and 16 tracheal resection were carried out, associated with thyroidectomy and neck dissection. The infiltrating mode and degree to the trachea in these patients were classified into 2 types according to the anatomical characteristics: Types of cartilage and membranous portions. Moreover, the former was further subclassified into 3 divisions. The subtype I of cartilage portion: Infiltration to the adventitia of trachea. Histologically, there were 3 well differentiated carcinoma, 3 poorly differentiated carcinoma and one medullary carcinoma. The prognosis was favorable comparing to other types. All 7 patients are alive. The subtype II or III of cartilage portion: Infiltration to the cartilage or annular ligament of trachea. Poorly differentiated carcinoma were noted in 6 of 7 patients. Five are alive and 2 died. The membranous type: Infiltration to the membranous portion of trachea. Esophageal invasion was noted in 7 patients. Undifferentiated carcinomas and squamous cell carcinoma took over a half of the patients. Two are alive and 7 died. The prognosis was the worst.     

Bronchial flap closure of the lower membranous trachea

A novel method for closure of the lower membranous trachea after right pneumonectomy using a flap derived from the cartilaginous portion of the right main bronchus is described in this study. This technique was used successfully in patients with tracheal stenosis due to a giant posterior mediastinal tumor known as schwannoma. Because of the severe tracheobronchial stenosis and destroyed right lung, tumor resection combined with resection of the lower membranous trachea and right pneumonectomy was carried out. We closed the defect in the membranous lower trachea with the flap derived from the right main bronchus. The clinical course was uneventful.     

Intrathoracic tracheal rupture following blunt chest trauma

Intrathoracic tracheal rupture following closed chest trauma is a potentially lethal injury which can be successfully repaired if the diagnosis is made early. Dyspnoea, mediastinal emphysema and pneumothorax which do not respond to intercostal tube drainage should alert the clinician to the possibility of intrathoracic tracheal rupture. A case is described. A 17-year-old boy sustained two longitudinal lacerations of the membranous portion of the intrathoracic trachea in association with blunt chest trauma. The diagnosis was delayed because of coexisting head injury. The tracheal lacerations were successfully repaired via a right thoracotomy. The principles of management in such injuries are reviewed.     

Tracheal laceration following double-lumen intubation during Ivor Lewis esophagogastrectomy

A case of a 48-year-old man with an iatrogenic membranous tracheal wall rupture after double-lumen intubation during Ivor Lewis esophagogastrectomy is presented. Tracheal injury was successfully managed surgically with the use of a bovine pericardial patch and reinforcement with the gastric conduit which was moved toward the posterior wall of the membranous trachea sealing the wall laceration.     

Obstructing tracheal lipoma: management of a rare tumor

Benign neoplasms of the trachea are rare. We describe a 46-year-old patient with a lipoma arising from the membranous trachea and causing severe respiratory obstruction. Investigation and management of this problem are discussed, and the literature is reviewed.     

Management of acute cervical tracheal trauma

Airway management is of primary concern in many patients with major penetrating or blunt trauma, particularly injury to the cervical trachea. Although such an injury is infrequent, it is an immediate threat to life and, if unrecognized, can lead to both early and delayed complications. Among more than 700 patients with major neck trauma seen during the past twenty-seven years at the Ben Taub General and Jefferson Davis Hospitals in Houston, Texas, sixty-five patients had injuries to the cervical trachea. In four, the injury extended to include the intrathoracic trachea and/ or main stem bronchus. The most severe injuries occurred in patients with blunt trauma, two requiring emergency cardiopulmonary bypass to accomplish extensive tracheobronchial repair. Tracheostomy was almost always employed. There were no operative deaths attributable to the tracheal injuries themselves. Early control of the airway, assessment of associated injuries, and employment of indicated adjunctive measures provided for successful management of these uncommon injuries.     

A case of carcinoma of the esophagus involving the trachea undergoing anterior mediastinal tracheostomy with pedicled omental wrapping

A 62-year-old male who complained of dysphagia, body weight loss and hoarseness was admitted to our hospital. Chest x-ray film disclosed right superior mediastinal mass compressing membranous portion of trachea. Esophageal fiberscope revealed carcinoma of cervical esophagus. Bronchofiberscope revealed the paralysis of right recurrent laryngeal nerve and the invasion of esophageal cancer to tracheal membranous portion from the 5th tracheal ring to the 12th. The cancer also invaded the right lobe of thyroid which was shown by echogram. Operation was performed. On dissecting the cervical region, it was found that the tumor invaded both sides of the trachea so that tracheal reconstruction could not be done without injuring left recurrent laryngeal nerve. Sternotomy was added. Anterior mediastinal tracheostomy was done after laryngeal resection with total thoracic esophagectomy and tracheal resection leaving 5 rings long cartilage from carina. The trachea was wrapped with pedicled omentum. Post-operative course was uneventful. This procedure helps to increase blood supply to the tracheal anastomosis and turns to advantage in preventing infectious extension around trachea to mediastinum as well as tracheal compression to major vessels.     

Intubation injuries of the trachea in children. Management and prevention.

The problem of intubation injuries of the trachea in children has been summarized. Preventive measures designed to protect the trachea from injury have been outlined. In spite of these measures, acute intubation injuries have occurred in 15 children. An aggressive approach combining bronchoscopic evaluation, intratracheal injection of steroids, tracheal stenting with an endotracheal tube and systemic steroids has been employed in the treatment of these injuries. We feel that this therapy has prevented the development of cicatrical stenosis in many of the cases and has allowed permanent decannulation of the trachea.     

Rupture of the trachea during difficult intubation

Serious injuries of the larynx or trachea during tracheal intubation are rare but potentially life-threatening complications. This case report describes the diagnostic procedures and therapeutic management of an intubation-induced tracheal rupture in a young female patient with a musculoskeletal disorder (rigid spine syndrome). Interdisciplinary treatment requires precise documentation of the extent of the injuries, including advanced imaging techniques. Removal of the endotracheal tube prior to accurate diagnosis can result in immediate airway obstruction. Because of the risk of infection, as a rule surgical treatment is indicated.     

Neglected Hangman's fracture in association with rupture of the trachea.

BACKGROUND CONTEXT: Rupture of the trachea combined with a Hangman's fracture has been reported rarely in the literature. We present a case of a rupture of the trachea combined with a type IV Hangman's fracture that remained undiagnosed for 7 weeks, in a 25-year-old woman after a road traffic accident. PURPOSE: To underline the necessity that physicians treating patients with multiple injuries including the trachea and the mediastinum should be aware of the fact that injuries of the trachea can be accompanied by trauma to other contents of the mediastinum and of the cervical spine. STUDY DESIGN: A 24-year-old woman was involved in a head on collision road traffic accident. She has suffered from a rupture of the trachea combined with a type IV Hangman's fracture that remained undiagnosed for 7 weeks. METHODS: Emergency surgical repair of the rupture of the trachea was performed. A halo vest for a total period of 4 months was applied. RESULTS: The patient followed a rehabilitation program, and, at her last visit, 12 months after her injury, had remained asymptomatic. A computed tomography scan of her cervical spine showed union through callous formation, and she had returned to her previous job and recreational activities. CONCLUSIONS: Physicians treating patients with multiple injuries including the trachea and the mediastinum should be aware of the fact that injuries of the trachea can be accompanied by trauma to other contents of the mediastinum and of the cervical spine.     

Tracheoplasty--a new operation for complete congenital tracheal stenosis

This is a report of a case of complete congenital tracheal stenosis confirmed by tracheobronchogram. The stenosis also involved the origin of the right main bronchus. The membranous portion of the trachea was absent. It was repaired through a sternotomy and right thoracotomy aided by partial cardiopulmonary bypass. The posterior trachea was opened from larynx to carina and on into the right main bronchus, and each posterior tracheal edge was sewn to the anterior wall of the esophagus with a running Prolene suture. Three months after repair bronchoscopy showed that the new membranous trachea was epithelialized and the entire airway was of good caliber; the only problem was a diffuse tracheomalacia. He died in his seventh postoperative month after a major airway complication due to tracheotomy, which occurred after an elective bronchoscopy. It is obvious that this operation is technically feasible. It was hoped that his airway would become sufficiently stable to allow the tracheotomy tube to be removed at some time in the future.     

Tracheal laceration with massive subcutaneous emphysema: a rare complication of endotracheal intubation.

Our patient sustained a laceration of the membranous portion of the trachea associated with massive subcutaneous emphysema after an apparently uneventful intubation. The patient was successfully operated on within seven hours. The importance of prompt diagnosis and treatment in the event of this rare complicatoin and the different causative factors are discussed.     

Severe injuries of the neck]

An analysis of the surgical tactics in 15 patients with severe combined neck traumas was carried out. All the patients recovered. There were 3 injuries to the trachea, 2 injuries to the larynx, 3 injuries to the pharynx and 2 injuries to the thyroid gland. 10 patients sustained traumas to the large vessels. Surgical tactics and results of the treatment are described.